Treatment of haemorrhoids is tailored to the type of presentation. It is wise to remember that more serious underlying problems in the rectum must be considered before recommending treament of the haemorrhoids.
If the presention is due to acute thrombosis, the patient is usually treated with be rest and analgesia, ice packs may also help. To avoid painful defectaion the patient is put on a low-residue diet and on stool softeners such as Lactulose. If the patient becomes more comfortable then excision of the haemorrhoids may be avoided untill the acute oedema and swelling have setteled. If the patient remains in severe pain then they are brought to theatre for an anal stretch or a formal haemorrhoidectomy. Haemorrhoidectomy is more difficult in this setting than in the elective setting.
In the more chronic type of presentation, resection is required if there is severe prolapse and external haemorrhoids. If there are no significant external components and the prolapse is minor, the patient is offered rubber banding or injection sclerotherapy.